Department of Pediatrics, Staten Island University Hospital, Northwell Health, Staten Island, New York (Dr Ilahi); Division of Neonatology, Department of Pediatrics, Staten Island University Hospital, Northwell Health, Staten Island, New York (Ms Capolongo and DiMeglio and Dr Rahman); and Biostatistics Unit, Feinstein Institutes for Medical Research, Northwell Health, Staten Island, New York (Dr Demissie).
Adv Neonatal Care. 2023 Jun 1;23(3):205-211. doi: 10.1097/ANC.0000000000001033. Epub 2022 Aug 30.
Poor feeding techniques result in adverse outcomes for preterm infants. Infant-driven feeding (IDF) is a structured feeding method that standardizes neonatal cue-based feedings, and matches the neurodevelopmental stage of the preterm infant. The purpose of this quality improvement project is to assess whether initiation of an IDF initiative impacts time from first nipple feed (NF) to full NF and to discharge in infants born before 35 weeks' gestational age. Secondary aims include assessment of the impact of IDF on neonatal growth and feasibility of following an IDF protocol in a level III neonatal intensive care unit (NICU).
This quality improvement project assesses differences in time to first NF, length of hospital stay, and neonatal growth before and after usage of an IDF protocol. Eighty infants were included, 40 prior to and 40 after IDF intervention. Nurses were trained on IDF philosophy and methods prior to initiation.
IDF was associated with discharge at a younger corrected gestational age (CGA), attainment of ad lib feeds at a younger CGA, and shorter amount of days between first NF and discharge. Infants utilizing IDF had slower weight gain, demonstrated by a larger drop in z score in the IDF group. The medical team and bedside nurses were able to follow the IDF protocol with few exceptions.
IMPLICATIONS FOR PRACTICE/RESEARCH: IDF allows for optimization of a preterm infant's NICU stay and prepares infants for a safe discharge sooner. This could lead to increased parental satisfaction and decreased hospital cost. Further studies are indicated to ensure these benefits remain and focus on impact direct breastfeeding plays in the IDF model.
不良的喂养技术会对早产儿产生不良后果。婴儿主导喂养（IDF）是一种结构化的喂养方法，它规范了基于新生儿暗示的喂养方式，并与早产儿的神经发育阶段相匹配。本质量改进项目的目的是评估启动 IDF 计划是否会影响出生前 35 周的婴儿从首次乳头喂养（NF）到完全 NF 和出院的时间。次要目标包括评估 IDF 对新生儿生长的影响，以及在三级新生儿重症监护病房（NICU）中遵循 IDF 方案的可行性。
本质量改进项目评估了在使用 IDF 方案前后，首次 NF 时间、住院时间和新生儿生长的差异。纳入了 80 名婴儿，40 名在 IDF 干预前，40 名在 IDF 干预后。在开始前，护士接受了 IDF 理念和方法的培训。
IDF 与更早的校正胎龄（CGA）出院、更早达到随意喂养、以及从首次 NF 到出院的天数更短相关。使用 IDF 的婴儿体重增长较慢，在 IDF 组中 z 分数下降更大。医疗团队和床边护士除了少数例外，都能够遵循 IDF 方案。
实践/研究意义：IDF 允许优化早产儿的 NICU 住院时间，并使婴儿更早地安全出院。这可能会增加家长的满意度并降低医院成本。需要进一步的研究来确保这些益处持续存在，并关注直接母乳喂养在 IDF 模式中的作用。
